A dear friend was recently diagnosed with a serious illness. In coping with her diagnosis and to keep friends and family updated on her treatment, she started an online blog. Her most recent post was thoughtful and reflective because it emphasized the importance of gratitude. She wrote about many of things she was grateful for and really didn’t focus on any of the negative feelings that can exist when coping with a serious disease. After all, it’s hard to be negative when you are talking about all that you have been blessed with.

It got me thinking about the whole mind-body connection and the role of gratitude and our health. As clinicians, we are focused on medications and evidence-based guidelines, but what about promoting gratitude as part of our treatment recommendations? What is the relationship between gratitude and health?

You’ve probably heard the term “vaping” a lot recently. It’s used to describe the use of e-cigarettes and experiencing the inhalation of the “vapors” from the product. Vape shops are cropping up everywhere in Philly, allowing customers to use e-cigarettes in their venues and tapping into the now billion dollar industry.

No doubt, sudden prevalence of these cafes is strengthening the marketing strategy for e-cigs, but it raises some questions, too. As a physician, it’s important for me to understand lifestyle habits of patients that may place their health at risk. I’ve added e-cigarettes to my history-taking list of questions. From a public-health perspective, here are some answers to some of the concerns:

I just had my baby and thankfully, all is going well. He’s thriving and I am having a much better post-partum experience this time than with my daughter. Despite lingering blood-pressure issues, carpal tunnel syndrome in my dominant hand and the stress of all the baby weight I want to lose, I am happy. I didn’t think it possible to feel this way, having struggled with my mood after my first pregnancy.

I’m at the tail end of my pregnancy and hopefully all will go well. I was recently told I have gestational hypertension—i.e. high blood pressure during pregnancy—and was handed a three-liter jug to collect a 24-hour urine specimen. I can’t tell you how many times I’ve asked a patient to do this very thing, but when faced with the task of doing it myself, I thought, How in the world am I going to do this while running around after a soon-to-be five-year-old? We’re talking every drop of urine, into this container, for an entire day. Oy!

There is no doubt that Obesity is an epidemic, not only here in Philadelphia, but across the United States. The reasons are many and now that the American Medical Association, as of June 2013, has classified obesity as a “disease”, physicians are even more compelled to address this complex issue in their practices. How they go about doing this is up for debate.

A recent study out of Johns Hopkins highlighted the issue of physicians judging their overweight patients, adding to the shame obesity can cause and making it difficult for patients to engage in partnership with their doctors to assist in medically supervised weight loss. In the study, which surveyed 600 overweight and obese adults in the U.S., 21 percent believed their doctor judged them because of their weight. And of those people, only 14 percent went on to actually lose a significant amount of weight. Read more »

Now that marijuana is being legalized in several states (Pennsylvania to follow, perhaps?), what health and safety issues will we face?

We’ve made huge strides in making tobacco-related health issues well known to the public and kids, regulating cigarette sales and promoting smoking cessation. I’m not equating tobacco to pot, but there are clearly still health issues that can arise. For example: an employee shows up to work high on marijuana, with visibly impaired judgment and makes a catastrophic error that leads to harm. Are we okay with this? Of course not—it’s no different than alcohol-related incidents. However, all this talk about legalizing marijuana has to be balanced with an ongoing discussion about its possible impact on concentration, judgment, memory and reaction time—all of which can be impaired with use.

Last year, several hospitals in Pennsylvania began testing incoming employment candidates for nicotine, in addition to routine drug and alcohol screening. Apparently, if a candidate has been given a job offer, gets tested at the employer’s occupational health clinic and screens positive for nicotine, he or she is deemed not medically cleared to begin work and, effectively, does not get the job.

As an occupational health physician, I am all for wellness programs and healthy lifestyles. And as a primary care physician schooled in patient-centered medicine, I understand how hard it is can be to make certain lifestyle changes, such as opting for healthier food and quitting smoking. In fact, one of the hardest clinical challenges for me has been to get my patients to quit smoking.

Do you check with guests about their food allergies before having a party? Every year we hear tragic stories of young lives lost from contact with peanuts, tree nuts or foods containing or exposed to nuts. Many schools are peanut- or tree nut-free zones, and we are seeing more and more food products carrying “school-safe” labeling. Not all kids with peanut allergies have other tree nut allergies, but for those that do, the issue can be even more challenging.

Peanut allergies can be very dangerous and cause a reaction known as anaphylaxis, which is a medical emergency. It can involve many symptoms including tongue and lip swelling, respiratory distress and cardiovascular collapse, which can result in death. It’s every parent’s worst nightmare. This being the holiday season, I felt it timely to write about a personal experience as a host dealing with this very issue.

It’s comforting at least to know that I’m not alone: A recent Los Angeles Times article confirms that more and more women older women are having babies. The diagnostic code for all my prenatal testing falls under “AMA”—advanced maternal age—so I am reminded at each and every prenatal visit that I am old. It has got me thinking about the implications of being nearly 40 when I have a newborn. For one, there’s a host of preventative health-screening recommendations for adults made by the U.S. Preventive Task Force. As new moms, how do we schedule mammograms, colonoscopies and other types of screenings while juggling mommyhood, breastfeeding, struggling to lose baby weight and maintaining some sort of anti-aging regimen that is safe while lactating?

This year we have a buffet of flu vaccine products to choose from, with at least five new ones on the market. Manufacturers have listened to consumers and the race is on to be the product of choice: mist vs. tiny needle, protection against three vs. four strains, egg-free, high dose for seniors, etc. The options are dizzying for physicians, let alone patients.

With multiple products, the conspiracy theorists can be less worried—more than one product for each age demographic is much more reassuring. Currently, the CDC does not endorse one product over the other but does identify at-risk populations and the recommended vaccines to confer the best protection possible. While the flu shot is not 100 percent effective, it is one of our best defenses against protecting ourselves and our most vulnerable populations by attempting to obtain high levels of compliance with the vaccine across all persons over the age of six months.

Health-care providers should help our patients navigate the choices, demystify myths and provide the tools necessary to understand the importance of vaccination in protecting oneself and those most vulnerable around us. With so many products to choose from, this task should be a little easier, but there must be a commitment to counseling patients.